Guide assembly for lateral implants and associated methods

ABSTRACT

A method for use in guiding a lateral fastener into a lateral bore of a femoral body implant. The method can use an outrigger having an arm portion, a leg portion that extends from the arm portion, and an alignment tube that extends from the leg portion. The method can further use a support pad and an adjustable shaft member that couples to the support pad and the leg portion. A shaft member can be adjustably maintained in a position relative to the leg portion by a quick-release system.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is claims priority from U.S. patent application Ser. No. 12/718,023 entitled “GUIDE ASSEMBLY FOR LATERAL IMPLANTS AND ASSOCIATED METHODS” filed on Mar. 5, 2010. The disclosure of the above application is incorporated herein by reference.

FIELD

The present teachings relate generally to a guide assembly for a trochanteric bolt and to a method of using the guide assembly.

BACKGROUND

The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.

In many reconstructive procedures of the hip joint, the greater trochanter can sometimes be resected from the proximal femur to provide access to the joint or a primary hip prosthesis, such as during a revision hip replacement procedure. The resected portion of the greater trochanter can be reattached after a revision femoral prosthetic component is implanted using, for example, bolts, wires, nails, etc. either alone or in combination. The greater trochanter may also fracture unintentionally during the insertion of a prosthetic implant and may require reattachment. Further, the greater trochanter may need to be partially resected and/or may include bone loss due to, for example, wear over time. In such circumstances, the greater trochanter may require additional support to compensate for the area of bone loss.

There is, therefore, a need for improved implants and associated guide instruments that facilitate lateral access to a hip prosthesis and allow easy alignment, insertion and removal of trochanteric bolts.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

In one form, an assembly is provided for use with a femoral body implant having a longitudinal axis and a lateral bore at an angle to the longitudinal axis at a proximal end of the femoral body implant, where the lateral bore is capable of receiving a lateral fastener to secure an implantable support plate to a lateral surface of the femur. The assembly can include an outrigger having an arm portion with a first end adapted to be coupled to the femoral body implant, and a second end having a leg portion extending at an angle from the arm portion so as to be substantially parallel with the longitudinal axis of the femoral body implant. The assembly can further include an alignment tube, a support and a quick-release system. The alignment tube can extend from the leg portion such that the alignment tube is adapted to be coaxial with the lateral bore and is adapted to facilitate inserting the lateral fastener into the lateral bore. The support can be adapted to maintain a position of the implantable support plate and can include a pad member configured to engage the implantable support plate and a shaft member pivotally coupled at a second end to the pad member and slidably received in the leg portion at a first end opposite of the second end. The quick-release system can adjustably maintain a position of the shaft member relative to the leg portion.

In another form, a method of using the guide assembly and associated implants is provided. The method can include providing a guide assembly having an outrigger with an arm portion, a leg portion, a support pad coupled to the leg portion, and an alignment tube extending from the leg portion. A medial end of the outrigger arm portion can be coupled to a proximal femoral body implanted in a femur such that the alignment tube is coaxial with a lateral bore in the proximal femoral body implant. An implantable support plate can be positioned adjacent to at least a portion of a lateral side of the femur and an alignment sleeve can be advanced against the support plate and tightened to a desired compression. The support pad can be engaged against a side of the support plate opposite the femur by moving a clamp member to a release position and advancing the support pad relative to the leg portion and into engagement with the support plate. The method can further include forming a bore in the femur coaxial with the lateral bore of the proximal femoral body implant by advancing a drill through the alignment tube until a stop member engages a first end of the alignment tube. A length of a lateral fastener can be determined by determining a position of a marker on an alignment sleeve relative to one of a plurality of indicia on the alignment tube, wherein the one of the plurality of indicia aligned with the marker corresponds to the required length of the lateral fastener. The alignment sleeve can be removed and the lateral fastener with the required length can be inserted through support pad and implantable support plate and into threaded engagement with the lateral bore of the proximal femoral body implant.

Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

DRAWINGS

The present teachings will become more fully understood from the detailed description, the appended claims and the following drawings. The drawings are for illustrative purposes only and are not intended to limit the scope of the present disclosure.

FIG. 1 is an exploded sectional view of an exemplary implant according to the present teachings;

FIG. 2 is a sectional environmental view of the implant of FIG. 1 according to the present teachings;

FIG. 3A is a sectional environmental view of the implant of FIG. 1 with an exemplary lateral augment according to the present teachings;

FIG. 3B is a sectional environmental view of the implant of FIG. 1 with another exemplary lateral augment according to the present teachings;

FIG. 4 is a perspective view of an implant body with an exemplary lateral augment according to the present teachings;

FIG. 5 is a sectional view of FIG. 4 according to the present teachings;

FIG. 6A is a medial perspective view of the exemplary lateral augment of FIG. 4 according to the present teachings;

FIG. 6B is a lateral view of the exemplary lateral augment of FIG. 4 according to the present teachings;

FIG. 7 is a perspective view of an implant body with an exemplary lateral augment according to the present teachings;

FIGS. 8A and 8B are lateral and medial perspective views of the exemplary lateral augment of FIG. 7 according to the present teachings;

FIG. 9 is a sectional view of FIG. 7 according to the present teachings;

FIGS. 10 and 10A are perspective views of an exemplary guide assembly with a left-handed outrigger coupled to an associated implant according to the present teachings;

FIG. 11 is perspective view of a removable sleeve of the guide assembly of FIG. 10 according to the present teachings;

FIG. 12 is a perspective view of a support pad of the guide assembly of FIG. 10 according to the present teachings;

FIG. 13 is a perspective view of the left-handed outrigger according to the present teachings;

FIG. 14 is a partial perspective view of the guide assembly of FIG. 10 according to the present teachings;

FIGS. 15-20B are sequential perspective views of the exemplary guide assembly illustrating use of the guide assembly in various stages of engagement and with alternative combinations of implants according to the present teachings;

FIG. 21 is a sectional view of an alternative implant assembly according to the present teachings;

FIG. 22 is an exploded perspective view of a ligament washer of implant assembly of FIG. 21 according to the present teachings;

FIG. 23 is a perspective view of an exemplary assembled configuration of the ligament washer of FIG. 22 according to the present teachings;

FIG. 24 is a sectional view of an alternative configuration of the implant assembly of FIG. 21 according to the present teachings; and

FIG. 25 is a sectional view of another alternative configuration of the implant assembly of FIG. 21 according to the present teachings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, its application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. In particular, the guide assembly of the present teachings can be used with any type of prosthesis for a bone, such as, for example, a proximal or distal femur, a proximal or distal tibia, a proximal or distal humerus, etc. Similarly, the lateral implants can include various types of implants such as, for example, a lateral augment or a claw plate, or combinations thereof. Therefore, it will be understood that the following discussions are not intended to limit the scope of the appended claims.

Referring initially to FIGS. 1 and 2, an exemplary implant 10 according to the present teachings can include a proximal femoral body implant 12 and a lateral support implant or claw plate 14. The proximal femoral body 12 can define a longitudinal bore 16 extending from a proximal end 18 along a longitudinal axis A and a blind bore 20 extending from a lateral side 22 towards a medial side 24 without surfacing on medial side 24 and having a longitudinal axis B. Blind bore 20 can be positioned at an acute angle α relative to longitudinal axis A. While blind bore 20 is shown as extending at an acute angle relative to longitudinal axis A, it should be appreciated that angle α can include various angles as may be desirable for different femoral body implant configurations. Bore 20 can include a threaded portion 26 and longitudinal bore 16 can also include a threaded portion 28 adjacent proximal end 18.

Proximal femoral body 12 can also include a neck portion 34 and a distal end 36 having a bore 38. Neck portion 34 can include a distal end 40 for receiving a spherical femoral head 42 that can mate with an acetabular cup 44, as shown in FIGS. 1 and 2. The femoral head 42 can be coupled to the neck portion 34 with a tapered connection, such as a Morse taper connection. Distal end bore 38 can include a female tapered configuration 46 that is configured to matingly receive a corresponding proximal male tapered end 50 of a distal stem extension 52 of implant 10. Tapered end 50 can include a blind threaded bore 54 configured to receive fastener 56 therein.

The implant 10 can further include a lateral fastener, such as a trochanteric bolt 60, having a threaded end 62 and a head 64. Trochanteric bolt 60 can be inserted into the lateral blind bore 20 from a lateral side 68 of the femur 70 through a lateral bore 72 drilled into femur 70. Lateral bore 72 can be coaxial with blind bore 20 and can be drilled into femur 70 using guide assembly 200 of FIG. 10, as will be described in more detail below. The threaded end 62 of trochanteric bolt 60 can engage threaded portion 26 of blind bore 20.

The claw plate 14 can be implanted laterally in soft tissue 80 adjacent to the femur 70 with the assistance of the guide assembly 200, as will also be described below in greater detail. Claw plate 14 can be used to provide support for soft tissue and/or a bone fragment, such as a portion 84 of a greater trochanter that has been broken off or resected, which may be required during a revision hip replacement procedure. The claw plate 14 can be retained in position by the head 64 of trochanteric bolt 60, with the head 64 being received in a countersunk bore 88 of claw plate 14, as shown in FIGS. 1-3. The claw plate 14 can have a variety of shapes depending on the particular application and can also be anatomically configured so as to have a shape that substantially conforms to the shape of the lateral side 68 of the femur 70 or the greater trochanter bone portion 84. The claw plate 14 can also include anchors or soft tissue piercing spikes 92 for soft tissue attachment.

With particular reference to FIG. 2, the proximal femoral body 12 can be coupled to the distal stem extension 52 with a Morse taper connection 96 such that the tapered proximal end 50 of the stem extension 52 is press fitted into the tapered distal bore 38 of proximal femoral body 12. The proximal femoral body 12 can be at least partially received in an intramedullary canal 98 of the femur 70. The distal stem extension 52 can also be locked to the proximal body 12 by fastener 56 being received in longitudinal bore 16 of proximal body 12 and engaging threaded bore 54 of stem extension 52. The proximal femoral body 12 and distal stem 52 can be implanted using a minimally invasive procedure or technique through a small anterior or posterior incision adjacent the left or right femur.

Referring additionally to FIGS. 3-9, implant 10 can also include lateral augments, such as lateral augments 102, 104, as may be required during a revision hip replacement procedure to provide for proper trochanter attachment. For example, if a portion of the greater trochanter needs to be resected and/or removed during a revision hip procedure to provide for removal of a primary hip implant, the augments 102, 104 can act as spacers to provide appropriate adjustment for the location of attachment of the trochanter to the proximal femoral body 12, as shown for example in FIG. 3A. The lateral augments 102, 104 can also be used during a revision hip replacement procedure to compensate for any bone loss adjacent the lateral side of the hip implant.

With particular reference to FIGS. 3A-6B, lateral augment 102 can include a substantially T-shaped configuration 108 having a body portion 110 with a lateral bone engaging surface 112 and a medial implant facing surface 114, and a cylindrical or tubular portion 118 extending from medial surface 114. Tubular portion 118 can include a tapered exterior surface 120 configured to be received in a mating tapered counterbore 124 formed into proximal femoral implant body 12, as generally shown in FIG. 5. The tapered exterior surface 120 and corresponding tapered counterbore 124 can be configured to provide a Morse taper connection 126 for coupling lateral augment 102 to proximal femoral body 12. Augment 102 can include an aperture 130 extending through body portion 110 and tubular portion 118 for receiving trochanter bolt 60 to secure claw plate 14 and T-shaped augment 102 to proximal femoral body 12, as generally shown in FIG. 3A.

Lateral augment 102 can further include a generally arcuate shape 136 corresponding to a mating shape on lateral side 68 of proximal femoral body 12. Lateral augment 102 can be configured with various lengths 138 and thicknesses 140, as may be required to provide for appropriate trochanter positioning and attachment during the revision hip procedure discussed above. Lateral surface 112 can also be provided with a roughened or porous metal coating to enhance biologic fixation, such as a layer of Regenerex® porous titanium construct 142, available from Biomet, Inc. of Warsaw, Ind. Alternatively, lateral augment 102 can be formed entirely out of porous metal.

Referring now to FIGS. 7-9, lateral augment 104 can include an L-shaped configuration 150 with a lateral surface 152, a medial surface 154, a lateral portion 156 and a superior portion 158 extending from lateral portion 156. Lateral surface 152 can include a layer of porous metal coating, such as the layer of Regenerex® 142 discussed above and as generally shown in FIG. 8A. In an alternative configuration, lateral augment 104 can be formed entirely out of porous metal. Lateral portion 156 can include a protrusion 160 extending from rear surface 154 and configured to engage a correspondingly shaped recess 162 in the proximal femoral body 12, as shown in FIGS. 8B and 9.

A first aperture 164 can be provided in lateral portion 156 and a second aperture 166 can be provided in top portion 158 such that when the L-shaped augment 104 is positioned on proximal femoral body 12, the first aperture 164 can be coaxially aligned with blind bore 20 and the second aperture 166 can be coaxially aligned with longitudinal bore 16, as shown in FIG. 9. Trochanter bolt 60 can be received through claw plate 14 and first aperture 164 and threadingly engaged with threaded bore 20 to couple claw plate 14 and lateral portion 156 to proximal femoral body 12, as generally shown in FIG. 3B. Second aperture 166 can receive a fastener 172 to secure superior portion 158 to proximal end 18 of proximal femoral body 12.

Referring now to FIGS. 10-14, and with continuing reference to FIGS. 1-9, after the proximal femoral body 12 has been implanted, as well as the T-shaped or L-shaped lateral augments 102 or 104 attached as may be required, the claw plate 14 can be implanted using guide assembly 200. In the exemplary application of a revision hip replacement, guide assembly 200 can provide for forming the lateral bore 72 and inserting the trochanteric bolt 60 therethrough and into engagement with the proximal femoral body 12 after the proximal body has been implanted in femur 70.

Guide assembly 200 can include an exemplary left-handed outrigger 210 that can take the form of a C-shaped arm 212, a leg or base portion 214 extending from a first or lateral end 218 of C-shaped arm 212, and a bore 220 (FIG. 13) extending through a second or medial end 222 of C-shaped arm 212. Outrigger 210 can be sized to be substantially rigid so as to avoid misalignment due to bending or flexing, and can be configured with the C-shape 212 to avoid the abductor muscles 223 of the hip joint during implantation of the trochanter bolt 60, claw plate 14 and one of the lateral augments 102, 104, if required. The left-handed outrigger 210 can be used laterally with anterior incisions of the left femur area or posterior incisions of the right femur area. It will be appreciated that while outrigger 210 is shown in FIG. 10 as well as all other applicable Figures in a “left-handed” configuration, the outrigger 210 can also be configured in a “right handed” configuration, which is a mirror image of the “left handed” outrigger 210. The right-handed outrigger can be used laterally with anterior incisions of the right femur area and/or posterior incisions of the left femur area. Therefore, it will be understood that while the remaining description will focus on the left-handed outrigger 210, the description is similarly applicable to the mirror-image right-handed outrigger.

Medial end 222 of C-shaped arm 212 can further include a slot-like protrusion 224 extending therefrom and configured to be received in a corresponding slot 226 positioned in proximal end 18 of femoral body 12, as shown in FIGS. 10 and 13 with reference to FIG. 5. The protrusion 224 can be used to align the guide assembly 200 to proximal femoral body 12 before coupling the C-shaped arm 212 thereto with a fastener 228, as well as to serve as an anti-rotation feature. The base portion 214 can include a lateral side 232 and a medial side 234, as well as a pair of parallel through bores 236 extending through base portion 214, as shown for example in FIG. 13. An alignment tube or sleeve 238 can be integrally formed with base portion 214 or modularly coupled thereto and can be coaxially aligned with another through bore 242 disposed in base portion 214, as shown in FIGS. 10, 10A and 14. When C-shaped arm 212 is coupled to proximal femoral body 12, base portion 214 can be parallel to longitudinal axis A and alignment tube 238 can be coaxial with longitudinal axis B of blind bore 20, as shown for example in FIG. 10.

The guide assembly 200 can also include a quick release clamp system 250, a removable sleeve 252, and a support pad 254 that cooperates with the clamp system 250 and sleeve 252. With particular reference to FIGS. 10, 10A and 14, the quick-release clamp system 250 can include first and second clamp members 260, 262 each pivotably coupled to base portion 214 via a hinge pin 264. Each of the clamp members 260, 262 can have an aperture 266 and an L-shaped configuration 270 that partially wraps around alignment tube 238, as generally shown in FIG. 10A. The apertures 266 can be co-axially aligned with respective through bores 236 in base portion 214 such that each respective aperture 266 and through bore 236 can slidably receive a cylindrical support rod 274 therethrough, as generally shown in FIGS. 10, 13 and 14. A coil spring 278 can be coupled at one end to each clamp member 260, 262 and at the other end to base portion 214, as generally shown in FIGS. 10A and 14.

The coil springs 278 can have an inner diameter sufficient for receiving one of the supports rods 274 therethrough as well as have an uncompressed length and spring force sufficient to urge respective clamp members 260, 262 away from base portion 214 to a first or locking position 272. In position 272, the clamp members 260, 262 can be positioned at a non-perpendicular angle relative to a longitudinal axis 276 of the cylindrical support rods 274, as generally shown in FIG. 10A. In this configuration, an inner surface 284 of apertures 266 can be misaligned with an exterior surface 286 of each support rod 274 so as to impinge on the support rods via the biasing force imparted by springs 278. The biasing force and resulting impingement of clamp members 260, 262 on support rods 274 serves to hold each support rod 274 in a desired fixed axial position.

To adjust a position of support rods 274 relative to clamp members 260, 262 and base portion 214, a user can depress or urge clamp members 260, 262 towards base portion 214 to a second or release position 280. In the second position 280, clamp members 260, 262 can be perpendicular or substantially perpendicular with longitudinal axis 276 and inner surfaces 284 of apertures 266 can be aligned with support rods 274. In this configuration, support rods 274 can be slidably axially translated relative to the respective clamp member 260, 262 to a desired position and then the respective clamp member 260, 262 can be released. Once released, springs 278 can urge clamp members 260, 262 from the second position 280 to the first position 272 where the clamp members impinge on support rods 274 so as to maintain the rods in the new or desired axially fixed position. It should be appreciated that while the above discussion of the quick-release clamp system 250 generally described clamp members 260, 262 being simultaneously moved from the first to second positions, each of the clamp members 260, 262 are separate components that can be used to individually or simultaneously adjust and lock a position of a corresponding support rod 274. Such individual adjustment of each support rod 274 can be used, for example, to align support pad 254 flush against claw plate 14, which can be at various angular orientations relative to the anatomy and longitudinal axis B.

With particular reference to FIGS. 10-11, the removable sleeve 252 can include a first end 290, a second end 292 and an internal longitudinal bore 294 extending through sleeve 252. The removable sleeve 252 can be received in alignment tube 238 so as to be coaxial therewith and can include an external threaded portion 296 configured to threadingly engage an internal threaded portion 300 of alignment tube 238, as generally shown in FIGS. 10 and 11. First end 290 of removable sleeve 252 can also include an engagement or drive portion, such as slot 302, configured to receive a driving tool (not shown) to advance or retract threaded sleeve 252 relative to alignment tube 238. The removable sleeve 252 can be advanced relative to alignment tube 238 to have second end 292 engage the claw plate 14 against the soft tissue before the trochanteric bolt 60 is implanted. The removable sleeve 252 can further include a suitable marking, such as scribe line 306, that can be visible through a window 308 in alignment tube 238. The alignment tube 238 can also include a measurement index or indicia, such as a plurality of trochanteric bolt 60 or fastener length designations 310, positioned adjacent the window 308 such that scribe line 306 can be correlated to one of the length designations 310, as will be described in greater detail below.

The removable sleeve 252 can receive a trephine or drill 316 in longitudinal bore 294 so as to align and guide drill 316 (FIG. 17) in forming lateral bore 72. Drill 316 can include a stop member, such as an annular collar 318, positioned on a body 320 of drill 316 configured to abut a first end 324 of alignment tube 238 when drill 316 is inserted into alignment tube 238 and removable sleeve 252, as will be described in greater detail below. The collar 318 can be positioned relative to a tip 328 of drill 316 such that a desired drill depth is achieved when collar 318 abuts alignment tube 238 during a procedure. It should be appreciated that drill 316 can include a plurality of drills 316 each with collar 318 positioned at various distances relative to tip 328 to correspond with different desired drill depths, as may be required, for example, by different size femoral implants 12 and/or the use of lateral augments 102, 104.

In an alternative configuration, and with additional reference to FIG. 18, a spacer sleeve 336 can be used as an alternative to the above described drill stop member arrangement. More specifically, as an alternative to using various drills 316 each with a differently positioned collar 318 corresponding at least to different implant configurations, one drill 340 can be used along with a plurality of different spacer sleeves 336, where each spacer sleeve 336 has a length 342 corresponding to a desired drill depth for the various implant configurations. Spacer sleeve 336 can include a longitudinal bore 344 configured to receive drill 340, a first end 346 arranged to abut portion 348 of drill 340, and a second end 350 configured to abut alignment tube 238 to serve as a stop to limit the drill depth to the predetermined amount that corresponds to the selected spacer sleeve 336.

With particular reference to FIG. 12, and continued reference to FIGS. 10-14, the support pad 254 can include a generally rectangular shape 360, an aperture 362 for slidably receiving removable sleeve 252 therethrough, and retention slots 364. The support pad 254 can be removable received on circular or spherical engagement members 368 positioned on respective ends of support rods 274. The retention slots 364 can include a generally cylindrical shape 370 with an arcuate surface or periphery 372 that extends for greater than 180 degrees such that the slots 364 can capture the engagement members 368 and couple support pad 254 to support rods 274. As one of ordinary skill in the art will appreciate, the circular or spherical engagement members 368 provide for the ability to orientate the support pad 254 in various angular orientations relative to the support rods 274.

Referring to FIGS. 15-20B, and with continuing reference to FIGS. 1-3B, a procedure for inserting the claw plate 14, trochanteric bolt 60 and lateral augments 102 or 104, as may be required, will now be described. Although the procedure is illustrated with respect to the left-handed outrigger 210, it should be appreciated that the procedure is similarly applicable to the right-handed outrigger discussed above. It should also be appreciated that the bone and soft tissue are not illustrated in FIGS. 16-20B so as to not obscure the illustration of the guide assembly 200. Reference is made to FIGS. 1-3B and 15 for illustration of the bone and soft tissue.

With the proximal femoral body 12 implanted, one of the lateral augments 102, 104 can be secured to the lateral side of femoral body 12, as may be required to provide proper positioning of the greater trochanter relative to proximal femoral body 12 and to account for the above noted bone loss. The outrigger 210 can be coupled to the proximal end 18 of proximal femoral body 12 and secured with fastener 228. Once coupled, alignment tube 238 can be coaxially aligned with blind bore 20, as shown in FIG. 15. The claw plate 14 can then be implanted and compressed against soft tissue 80 adjacent the femur 70 by advancing removable sleeve 252 such that second end 292 engages claw plate 14, as generally shown in FIGS. 16-17 with reference to FIGS. 1-3B. It should be appreciated that claw plate 14 can be adjusted superiorly or inferiorly relative to longitudinal axis B, as may be required based on various anatomical conditions. A suitable driver (not shown) can be coupled to the first end 290 of removable sleeve 252 so as to engage slot 302 and assist in advancing removable sleeve 252 to compress claw plate 14.

Once claw plate 14 is compressed with removable sleeve 252, clamp members 260, 262 can be independently depressed to release support rods 274. Support rods 274 can then be individually or simultaneously translated forward to engage support pad 254 with claw plate, as shown in FIGS. 16-17. Support pad 254 includes a smooth engagement surface 255 for engaging claw plate 14; however, support pad 254 can alternatively include projections 374 that engage slots 90 in claw plate 14, as also shown in FIG. 17. Once support pad 254 is engaged with claw plate 14, clamp members 260, 262 can be released thereby maintaining the position and support rods 274 and thus support pad 254.

With additional reference to FIGS. 17-18, the appropriately sized drill 316 corresponding to the implanted femoral body 12 and lateral augment 102, 104, if used, can be inserted into longitudinal bore 294 of removable sleeve 252 to drill the lateral bore 72 into the femur 70 from the lateral side 68. The drill 316 can be advanced until collar 318 engages alignment tube 238, as shown in FIG. 17. Alternatively, drill 340 could be used with an appropriately selected spacer sleeve 336 to form the lateral bore 72.

Once bore 72 is formed, drill 316 or 340 can be removed from sleeve 252 and an appropriate trochanteric bolt length can be determined by correlating the scribe line 306 with the length designations 310 on alignment tube 238. The length designation 310 aligned with scribe line 306 can correspond to the appropriate trochanteric bolt 60 length required to secure claw plate 14 to blind bore 20 while taking into account the thickness of bone and/or soft tissue being compressed by claw plate 14. It should be noted that the appropriate fastener length can also be determined before bore 72 is formed, such as after claw plate 14 is compressed by advancing removable sleeve 252.

With the appropriate trochanteric bolt length determined by selecting a bolt length corresponding to the length designation 310 aligned with scribe line 306, sleeve 252 can be removed from alignment tube 238 while support pad 254 continues to compress claw plate 14 in place via support rods 274, as generally shown in FIG. 19. The selected trochanteric bolt 60 can then be implanted by passing bolt 60 through alignment tube 238 and aperture 362 of support pad 254 such that threaded end 62 engages threaded portion 26 of blind bore 20. Trochanteric bolt 60 can then be tightened such that head 64 engages and secures claw plate 14, as generally shown in FIGS. 20-20B with reference to FIG. 2-3B. Once the trochanteric bolt 60 is implanted and secured, the guide assembly 200 can be removed from proximal femoral body 12.

With additional reference to FIGS. 21-25, an alternative lateral implant 400 for attaching the soft tissue 80 to proximal femoral body 12 will now be described. Lateral implant 400 can include a generally T-shaped plate member 410 having a proximal end 412, a distal end 414, a lateral surface 416 and a medial surface 418 opposite lateral surface 416. The plate member 410 can include a tapered projection 422 extending from medial surface 418 and configured to be received in tapered counterbore 124 of proximal femoral body 12 and coupled thereto via a Morse taper connection 424. An aperture 426 can be provided in plate member 410 extending through projection 422 so as to be coaxial with blind bore 20 when the tapered projection 422 is received in counterbore 124, as generally shown in FIG. 21. A fastener 428 can be received through aperture 426 and threadingly engaged to bore 20 to secure plate member 410 to proximal femoral body 12, as generally shown for example in FIG. 21.

Plate member 410 can be configured to have a length 432 such that proximal end 414 extends sufficiently beyond proximal end 18 of femoral body 12 so as to provide for adequate soft tissue 80 attachment and support. Plate member 410 can also include a layer of porous metal coating, or can alternatively be formed entirely of porous metal. A pair of threaded blind bores 444 can be provided in plate member 410 extending from front surface 416. Bores 444 can be configured to receive a corresponding pair of fasteners 446 for securing soft tissue 80 to a lateral side of plate member 410, as generally shown in FIG. 21. Proximal end 414 can also include an attachment member, such as a sharp projection or tooth 438, to assist in attaching and retaining soft tissue 80.

In an alternative configuration, plate member 410 can include blind bores 444 extending from the medial surface 418, as generally shown in FIG. 24. In this configuration, the soft tissue 80 would be compressed against the medial surface of plate member 410, as also shown in FIG. 24. In another alternative configuration, plate member 410 can be angled so as to align with a force generated by the soft tissue, as generally shown in FIG. 25.

Lateral implant 400 can also include ligament washers 450 for use with fasteners 446. Each ligament washer 450 can include a body portion 452 and an optional insert 454 configured to abut body portion 452, as shown in FIGS. 22-23 and generally described in commonly owned co-pending application Ser. No. 12/398,548, entitled “Method and Apparatus for Attaching Soft Tissue to an Implant,” the entirety of which is hereby incorporated by reference herein. Body portion 452 can include a fastener engaging side 456, a soft tissue facing side 458, an aperture 460 and a plurality of circumferentially spaced ligament engagement members 462. The soft tissue facing side 458 can be configured to engage the soft tissue 80 directly or receive insert 454. Insert 454 can be configured to facilitate biologic fixation and can be coated with a layer of Regenerex® for such purpose. Alternatively, insert 454 can be formed entirely of porous metal. The plurality of bone engagement members 462 can each include a tapered configuration 464 formed with a base portion 466 attached to the soft tissue facing side 458 and a body portion 468 with multi-faceted side portions 472 that taper to a pointed distal tip 474. Insert 454 can further include a plurality of peripheral cut-outs or recesses 476 corresponding to the plurality of engagement members 462 such that each engagement member 462 is received in a recess 476, as generally shown in FIGS. 22-23. In use, the ligament washers can be received on fasteners 446 such that the insert 454 and engagement members 462 contact the soft tissue when the fasteners are secured to plate member 410, as shown in FIGS. 21 and 24-25.

While one or more specific examples have been described and illustrated, it will be understood by those skilled in the art that various changes may be made and equivalence may be substituted for elements thereof without departing from the scope of the present teachings as defined in the claims. Furthermore, the mixing and matching of features, elements and/or functions between various examples may be expressly contemplated herein so that one skilled in the art would appreciate from the present teachings that features, elements and/or functions of one example may be incorporated into another example as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. 

What is claimed is:
 1. A method for positioning a femoral body implant, comprising: providing a guide assembly having an outrigger with an arm portion, a leg portion, a support pad coupled to the leg portion, and an alignment tube extending from the leg portion; coupling a medial end of the outrigger arm portion to a proximal femoral body implanted in a femur such that the alignment tube is coaxial with a lateral bore in the proximal femoral body implant; positioning an implantable support plate adjacent to at least a portion of a lateral side of the femur; advancing an alignment sleeve against the support plate and tightening to a desired compression; forming a bore in the femur coaxial with the lateral bore of the proximal femoral body implant by advancing a drill through the alignment tube until a stop member engages a first end of the alignment tube; engaging the support pad against a side of the support plate opposite the femur by moving a clamp member to a release position and advancing the support pad relative to the leg portion and into engagement with the support plate; and inserting a lateral fastener with a selected length through the support pad and implantable support plate and into threaded engagement with the lateral bore of the proximal femoral body implant.
 2. The method of claim 1, further comprising: determining the selected length of the lateral fastener by determining a position of a marker on the alignment sleeve relative to one of a plurality of indicia on the alignment tube, wherein the one of the plurality of indicia aligned with the marker corresponds to the required length of the lateral fastener;
 3. The method of claim 2, wherein determining a length of a fastener further includes threadably inserting the alignment sleeve into a threaded longitudinal bore in the alignment tube such that the marker on the alignment sleeve is visible through an aperture in the alignment tube adjacent the length designations when the alignment sleeve is advanced into engagement with the implantable support plate.
 4. The method of claim 2, wherein removing the alignment sleeve further comprises removing the alignment sleeve while maintaining the position of the implantable support plate with the support pad.
 5. The method of claim 1, wherein advancing an alignment sleeve against the support plate and tightening to a desired compression further comprises compressing the implantable support plate against the femur and associated soft tissue with the alignment sleeve by axially advancing the alignment sleeve relative to the alignment tube and into engagement with the implantable support plate.
 6. The method of claim 1, wherein engaging a support pad further comprises pivoting a pair of clamp members coupled to the leg portion, which are individually biased to a locked position, to an unlocked position to release a corresponding support rod such that the respective support rod can be advanced thereby advancing the support pad into engagement with the support plate.
 7. The method of claim 6, further comprising releasing the clamp members such that a biasing member biases the clamp members to the locked position thereby maintaining the position of each support rod and thereby the support pad against the support plate.
 8. The method of claim 1, further comprising coupling a lateral augment to a lateral side of the proximal femoral body before positioning the implantable support plate.
 9. The method of claim 8, wherein inserting the lateral fastener includes inserting the lateral fastener with the selected length through the support pad, implantable support plate, and lateral augment and into engagement with the lateral bore of the proximal femoral body implant.
 10. A method for positioning a femoral body implant, comprising: providing an outrigger having an arm portion with a first end adapted to be coupled to the femoral body implant, and a second end having a leg portion extending at an angle from the arm portion so as to be substantially parallel with the longitudinal axis of the femoral body implant; positioning an alignment tube that extends from the leg portion such that the alignment tube is coaxial with a lateral bore formed in the femoral implant body and is adapted to facilitate inserting a lateral fastener into the lateral bore; supporting an implantable support plate in a position with a pad member adapted to engage the implantable support plate and a shaft member having a first end slidably received in the leg portion and a second end opposite the first end pivotally coupled to the pad member; and providing an adjustable quick-release system for adjustably maintaining a position of the shaft member relative to the leg portion.
 11. The method of claim 10, wherein providing the outrigger having the arm portion includes providing a C-shaped arm portion with a lateral opening that is substantially parallel to the longitudinal axis of the femoral body implant and configured to allow at least one of abductor muscles or femoral bone to pass through the C-shaped arm portion.
 12. The method of claim 10, wherein providing the quick release system comprises selectively coupling a clamp member to the leg portion and the first end of the shaft member between a lock position and a release position.
 13. The method of claim 12, further comprising: operating the provided quick-release clamp system comprising: coupling a spring to the clamp member and the leg portion; receiving the shaft member through an aperture in the clamp member; positioning the spring to bias the clamp member to the lock position where a longitudinal axis of the clamp member is positioned at an acute angle relative to a longitudinal axis of the shaft member such that an inner surface of the aperture impinges on the shaft member thereby maintaining a position of the shaft member relative to the clamp member; and pivoting the clamp member such that a longitudinal axis of the clamp member is substantially perpendicular with the longitudinal axis of the shaft member, such that the shaft member translates freely relative to the clamp member.
 14. The method of claim 13, wherein providing the quick release system further comprises: spacing two shaft members apart from each other such that the leg portion slidably receives each shaft member in the leg portion and pivotally couples to the support pad, and providing two clamp members each receiving one of the shaft members through the respective aperture; wherein each clamp member of the two clamp members is independently operable such that each shaft member can be independently adjusted relative to the other such that the support plate is capable of being positioned at a plurality of angular orientations relative to the longitudinal axis of the femoral body implant.
 15. The method of claim 10, further comprising: adjustably receiving an alignment sleeve in the alignment tube so as to be coaxial therewith and adjustably extend therefrom; wherein the alignment sleeve is adapted to be orientated substantially transverse to the implantable support plate and configured to be advanced from the alignment tube so as to be adapted to engage the implantable support plate and compress the support plate against soft tissue adjacent a lateral side of the femur.
 16. The method of claim 15, further comprising: receiving a drill in a longitudinal through bore of alignment sleeve and adapted to form a lateral bore in a femur coaxial with the lateral bore of the femoral body implant; and engaging a stop member at a first end of the drill that is configured to engage a first end of the alignment tube, the drill having a length from the stop member to a second end opposite of the first end to correspond with a size of the femoral body implant such that a tip of the second end is spaced apart from the implant when the stop member engages the first end of the alignment tube.
 17. The method of claim 16, further comprising: slidably receiving the alignment sleeve through an aperture in the support pad.
 18. A method of positioning a femoral implant body, comprising: providing a guide assembly having an outrigger with an arm portion, a leg portion, and a support pad coupled to the leg portion; coupling a first end of the outrigger arm portion to a proximal femoral body implanted in a femur; positioning an implantable support plate adjacent to at least a portion of a lateral side of the femur; configuring an alignment sleeve to be advanced against the support plate and tightened to a desired compression; and engaging the support pad against a side of the support plate opposite the femur by moving a quick release clamp member to a release position and advancing the support pad relative to the leg portion and into engagement with the support plate.
 19. The method of claim 18, further comprising: coupling an alignment tube to extend from the leg portion; providing a drill having a first end with a collar and a second end opposite the first end; and providing a spacer sleeve having a longitudinal bore configured to receive the drill such that a first end of the sleeve engages the collar and a second opposite end engages a first end of the alignment tube when the drill is inserted through the alignment sleeve, the spacer sleeve having a longitudinal length sized to correspond with a selected size of the femoral body implant such that the tip of the drill terminates spaced apart from the femoral body implant when the second end of the spacer sleeve engages the first end of the alignment tube.
 20. The method of claim 19, further comprising: forming a bore in the femur coaxial with the lateral bore of the proximal femoral body implant by advancing the provided drill through the alignment tube until a stop member engages a first end of the alignment tube; and inserting a lateral fastener with a selected length through the support pad and implantable support plate and into threaded engagement with the lateral bore of the proximal femoral body implant. 